End Stage Renal Disease (ESRD) is a large public health problem with a three-fold rise in prevalence over the past three decades. The only current medical restorative therapy for ESRD patients is kidney transplantation. Kidney transplantation however is marred by a scarcity of kidney organs. As a result of this organ shortage and other compounding system-related factors, a significant geographic disparity exists across the country with respect to the median waiting time ESRD waitlisted patients must wait to receive a kidney transplant.17,18 Currently, the median waiting time varies between 0.93 and 4.14 years depending on a patient's geographic area of waitlisting. 19 This waiting time to transplantation differential disproportionally affects the quality of life of ESRD patients waitingin different areas of the country. 12-14 There is general awareness within the transplant community of this geographic inequity, 24 yet to date, little has been proposed to curtail this disparity. Within this proposed research, we intend to investigate this geographic disparity in two ways. First, we intend to complete secondary data analysis with respect to multiple transplantation databases to comprehensively account for the cause and scope of the present inequities. Secondly, we aim to investigate current kidney organ allocation policy from an engineering perspective to develop alternative, optimized kidney organ sharing strategies to improve geographic equity in kidney organ allocation policy through minimal proposed modifications to the present policy. Through this multi-disciplinary effort within the Northwestern University Transplant Outcomes Research Collaborative (NUTORC), our research team hopes to have a significant impact on the present kidney allocation policy debate. For approximately eight years, the United Network of Organ Sharing (UNOS) Kidney Committee has analyzed the present kidney organ allocation policy, and recently proposed modifications to the current kidney allocation policy which are open for current public comment.30, 35 During this process, the significant geographic disparity in kidney organ allocation has been recognized as an important component to be investigated in the near future.34 With the UNOS Kidney Committee Chair-elect, Dr. John Friedewald, as an investigator within our research team, we intend to work closely with key members within this committee to impact and contribute to the future policy discussion with regards to this important issue. In total, a comprehensive understanding of the current geographic disparity in kidney organ allocation and potential interventions to lessen its effects will improve fairness within the transplantation process through lessening the disproportionate geographic patient experiences throughout the kidney transplantation process. In addition, we anticipate that the strategic kidney organ sharing mechanisms created may increase the efficiency with which the kidney organ allocation policy functions in practice and thus correspondingly increase the utilization of procured kidney organs for transplantation. PUBLIC HEALTH RELEVANCE: Current geographic disparities in kidney organ allocation have disproportionally affected the quality of life of ESRD patients living around the country due to th variability in waiting time to kidney transplantation. Through this collaboration, we will lessen disparate ESRD patient experiences throughout the United States by understanding current system inequities and creating kidney organ sharing strategies by which to curtail the disparity. In addition, through the creation of strategic, streamlined kidney organ sharing mechanisms, we aim to increase the efficiency of the kidney organ allocation process, and as a result, increase the utilization of procured kidney organs to increase the quantity of potential kidney transplantations.